I introduced this topic on my previous post about how the system is forcing more doctors to just check the boxes instead of treating the individual patient. Here are 7 specific signs to detect this problem:
1.The doctor mostly asks you yes/no questions
Yes/no questions work great for a computerized algorithm. It is easy to check the boxes off and comply with all the regulations by asking this type of questions. However, yes/no questions rarely get to the bottom of your problem. The real diagnosis is in the story of your illness. What you actually felt when you were sick is the key to uncover your diagnosis. This information does not come out in a format that can be categorized into discrete data and entered into a computer. The story of your illness is a unique story and depends on your personal situation. Only a human doctor can listen to your story and make sense of what could be going on inside your body. When that doctor is forced to enter your symptoms in discrete pre-selected phrases into a computer, it becomes hard to look at the big picture; the doctor’s mind gets pre-occupied in gathering the data. That is why doctors who check boxes seem to mainly ask yes/no type questions instead of listening to your unique story.
2. The doctor interrupts you too quickly
The doctor who is just collecting data naturally gets frustrated when you go off-topic. When you start to describe your symptoms in a way that can not be summarized in a medical phrase, the doctor gets frustrated and tries to steer you back to symptoms that can be categorized. If you described your symptoms exactly the way you experienced them and your doctor keeps interrupting you, your doctor may be just checking the boxes.
3. The doctor has ordered too many tests, more than what you discussed
Doctors who are used to checking boxes do not just check them off when documenting your symptoms, they also check those boxes when ordering diagnostic tests. Usually, they make their decisions based on pre-defined algorithms and check generic order-sets without individualization. These order sets are designed to capture all things that can go wrong when you have a particular set of symptoms. If the doctor just used common sense, he could have crossed off things that would not apply to your situation. Unfortunately, blindly checking off the order set is more common than you think. This is the reason why they sometimes run a pregnancy test in a 90 year old female with abdominal pain.
4. The doctor is typing on the computer the whole time
This one is very obvious. He is actually checking the boxes right in front of you. He asks you a question and checks a box. Sometimes, it is the insurance company or the government that forces him to check all the boxes in order to get paid. At other times, he is so busy that he has to multi-task by finishing the paperwork while talking to you. In any case, this kind of distraction makes it very hard for your doctor to focus on your unique story and that is a reason for great concern.
5. The doctor sounds unnatural and scripted
If your doctor’s questions remind you of a telephone survey, your doctor may be checking the boxes. Questions with long sentences that sound scripted are probably taken from a set of questions the doctor is supposed to ask every patient with certain symptoms. If your conversation with the doctor consists mostly of this type of questions, the doctor may be blindly following the protocol without any attempt to find the true diagnosis. Open ended questions that allow and encourage you to describe your symptoms in your own words have the power to extract the most important information needed to find the true diagnosis.
6. The doctor does not seem to be interested in you as a person
If your doctor wants to find out what your symptoms really mean, it is important for the doctor to know who you are. Your occupation, your family situation, your life stresses and other personal things have a big impact on the true significance of your symptoms. Knowing you as a person helps the doctor find your diagnosis early. When the doctor is focussed on gathering data, it is hard to know you as a person. The data gathering may require the doctor to ask questions like, “Do you smoke?” or “Are you under any stress?” or “Do you feel depressed?” but these type of questions rarely convey an interest in you as a person. A doctor who expresses a genuine interest in you as a person not only helps you feel comfortable, but also helps gather critical information about your life that may help nail the correct diagnosis. If you feel like the doctor is not interested to know you as a person and is just focussed on data gathering, he may be checking the boxes.
7. You feel like your doctor is not really listening to you
When your doctor is focussed on gathering data and checking the box, he is not really listening to you. He is simply looking for certain symptoms that he can check off the list. He may correctly identify all your symptoms and jot those down on his computer but you will get a feeling that he is not really listening to you. Trust your feeling, trust your instincts. If you feel like your doctor is not really listening to you, you are probably right.
I will tell you what you can do to try to make the doctor listen to you in the next post. Please do not hesitate to share your thoughts and opinions on the topic.